The results of ORIF of displaced unstable proximal humeral fractures using a locking plate

Background/hypothesis: Surgical management of displaced unstable proximal humerus fracture remains a challenge due to poor proximal bone quality and significant deforming forces. We hypothesized that the technique of application and mechanical properties of the proximal humeral locking plate would allow successful treatment of unstable and displaced proximal humeral fractures even in the face of osteoporotic bone. Method: We evaluated prospectively the results of open reduction internal fixation of 22 displaced unstable proximal humerus fractures in 22 patients utilizing a proximal humeral locking plate. Results: Results according to the ASES scoring system at a minimum of 2 years were excellent in 13, good in 4, fair in 1, and poor in 3. One patient was lost to follow-up. All fractures healed. Anatomic alignment was obtained in 72%. Two patients developed avascular necrosis of the humeral head. There were no cases of hardware failure, infection, or loss of reduction. Three separate reduction maneuvers were employed in this series depending on fracture type. Conclusion: The locking plate is an excellent device in the management of displaced unstable proximal humeral fractures and is expanding the indications for ORIF in these fractures.